Seeing the Other: How Residents Expand Their Perspective by Learning With the Arts.

Background: Engaging with the arts can enrich medical education by fostering transformative learning, reflection, and a holistic view of the patient. Objective: To explore the development of professional competence of residents in prolonged arts-based medical education. Methods: We followed residents (n=99) of various specialties as they engaged in arts-based learning through creative and reflective assignments such as painting, sculpting, and formal analysis. Participants were interviewed about their learning process and experiences, one-on-one and in small groups, by independent researchers using short, semistructured interviews. We used grounded theory to inform an iterative process for data collection and analysis over the course of 3 years (2016-2018). Results: Seven themes were constructed, which showed that (1) slowing down education provides room for reflection; (2) absence of judgment and rules sparks experimentation; (3) engaging with emotions fostered reflection and motivation; (4) the artists' methods provided a perspective change; (5) a holistic view on the patient emerged; (6) residents understood the need to take control over their professional development; and (7) there were barriers to overcome in terms of hierarchy and expectations. Our investigation shows that interns and residents undergo a perspective transformation. Key to the development of the physicians in training is the open and affective nature of the arts in education. Conclusions: Arts-based learning results in a new perspective for physicians in training in line with patient-centered health care and self-directed learning.

Integrative medicine and health in undergraduate and postgraduate medical education.

Background and objective: Integrative Medicine and Health (IMH) is a theory-based paradigm shift for health, disease and health care, which can probably only be achieved by supplementing medical roles and competences. Definition of IMH: The definitions of the Academic Consortium for Integrative Medicineand Health 2015 and the so-called Berlin Agreement: Self-Responsibility and Social Action in Practicing and Fostering Integrative Medicine and Health Globally are used. The basic features of evidence-based Integrative Medicine and Health (EB-IMH) are based on the recommendations on EBM by David L. Sackett. Global State of Undergraduate and Postgraduate Medical Education (UG-PGME) for IMH: The USA and Canada are most advanced in the development of IMH regarding practice, teaching and research worldwide. Despite socio-cultural peculiarities, they can provide guidance for Europe and especially for Germany. Of interest here are competences for UG-PGME in IMH in primary care and in some specialist disciplines (e.g. internal medicine, gynecology, pediatrics, geriatrics, oncology, palliative care). For these specialties, the need for an interprofessional UG-PGME for IMH was shown in the early stages of development. UG-PGME for IMH in Germany: In the course of the development of the new Medical Licensure Act in Germany (ÄApprO), based on a revision of the National Competence-based Catalogue of Learning Objectives for Medicine (NKLM 2.0) and new regulations for Postgraduate Medical Education in Germany, suggestions for an extension of UG-PGME are particularly topical. To some extent there are already approaches to IMH. Old and new regulations are set out and are partly compared. As a result, some essential elements of IMH are mapped in the new ÄApprO. The new regulations for Postgraduate Medical Education do not mention IMH. Conclusion: The development of medical competences for IMH in the continuum of the UG-PGME could be supported by the coordinated introduction of appropriate entrustable professional activities (EPA) and IMH sub-competences combined with appropriate assessment.

The flipped classroom: a novel approach to physical examination skills for osteopathic medical students.

CONTEXT: Medical students are faced with the challenge of synthesizing large volumes of information quickly. With the increasing accessibility of technology, a "flipped classroom" allows students to learn foundational material independently. Class time is instead devoted to in-depth skill building with instructors, promoting an active learning environment. This method of content delivery is also relevant given the current COVID-19 pandemic. OBJECTIVES: To comprehensively evaluate the benefit of adopting a flipped classroom approach in teaching physical exam skills (PES) to first-year osteopathic medical students. METHODS: A cohort study was conducted comparing first-year osteopathic students in the class of 2022 (n=201), who had taken the PES course traditionally, with the class of 2023 (n=203), who experienced the flipped classroom approach. Objective metrics such as cumulative grades, objective structural clinical examination performance (OSCE), and practical exam performance were compared using nonparametric Mann-Whitney U rank sum tests. Subjective measures such as student course evaluations were used to analyze course perceptions using independent sample t-tests assuming unequal variances. A faculty survey was administered to faculty who taught both cohorts to assess instructor attitudes toward the flipped classroom approach. Due to the COVID-19 pandemic, Spring 2020 quarter data was not included, given the transition of all classes to an online learning environment. RESULTS: The flipped classroom approach significantly improved objective student performance for the Fall (p=0.009) and Winter (p<0.001) student cumulative grades and the History-Taking OSCE (p=0.010). Performance on Fall and Winter practical exam scores had no significant association with the flipped classroom. General student perceptions of the course remained unchanged between both cohorts. Faculty survey results from 10 faculty members showed that six (60%) faculty members preferred the traditional classroom, while four (40%) preferred the flipped classroom. CONCLUSIONS: The flipped classroom approach showed some statistically significant improvement in student PES. Further studies are needed to evaluate the benefits of a flipped classroom approach using skills-based assessments styles to measure student performance, with a focus on standardization of in-classroom groupwork.

Interventions for improving medical students' interpersonal communication in medical consultations.

BACKGROUND: Communication is a common element in all medical consultations, affecting a range of outcomes for doctors and patients. The increasing demand for medical students to be trained to communicate effectively has seen the emergence of interpersonal communication skills as core graduate competencies in medical training around the world. Medical schools have adopted a range of approaches to develop and evaluate these competencies. OBJECTIVES: To assess the effects of interventions for medical students that aim to improve interpersonal communication in medical consultations. SEARCH METHODS: We searched five electronic databases: Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PsycINFO, and ERIC (Educational Resource Information Centre) in September 2020, with no language, date, or publication status restrictions. We also screened reference lists of relevant articles and contacted authors of included studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs), cluster-RCTs (C-RCTs), and non-randomised controlled trials (quasi-RCTs) evaluating the effectiveness of interventions delivered to students in undergraduate or graduate-entry medical programmes. We included studies of interventions aiming to improve medical students' interpersonal communication during medical consultations. Included interventions targeted communication skills associated with empathy, relationship building, gathering information, and explanation and planning, as well as specific communication tasks such as listening, appropriate structure, and question style. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. Two review authors independently reviewed all search results, extracted data, assessed the risk of bias of included studies, and rated the quality of evidence using GRADE. MAIN RESULTS: We found 91 publications relating to 76 separate studies (involving 10,124 students): 55 RCTs, 9 quasi-RCTs, 7 C-RCTs, and 5 quasi-C-RCTs. We performed meta-analysis according to comparison and outcome. Among both effectiveness and comparative effectiveness analyses, we separated outcomes reporting on overall communication skills, empathy, rapport or relationship building, patient perceptions/satisfaction, information gathering, and explanation and planning. Overall communication skills and empathy were further divided as examiner- or simulated patient-assessed. The overall quality of evidence ranged from moderate to very low, and there was high, unexplained heterogeneity. Overall, interventions had positive effects on most outcomes, but generally small effect sizes and evidence quality limit the conclusions that can be drawn. Communication skills interventions in comparison to usual curricula or control may improve both overall communication skills (standardised mean difference (SMD) 0.92, 95% confidence interval (CI) 0.53 to 1.31; 18 studies, 1356 participants; I² = 90%; low-quality evidence) and empathy (SMD 0.64, 95% CI 0.23 to 1.05; 6 studies, 831 participants; I² = 86%; low-quality evidence) when assessed by experts, but not by simulated patients. Students' skills in information gathering probably also improve with educational intervention (SMD 1.07, 95% CI 0.61 to 1.54; 5 studies, 405 participants; I² = 78%; moderate-quality evidence), but there may be little to no effect on students' rapport (SMD 0.18, 95% CI -0.15 to 0.51; 9 studies, 834 participants; I² = 81%; low-quality evidence), and effects on information giving skills are uncertain (very low-quality evidence). We are uncertain whether experiential interventions improve overall communication skills in comparison to didactic approaches (SMD 0.08, 95% CI -0.02 to 0.19; 4 studies, 1578 participants; I² = 4%; very low-quality evidence). Electronic learning approaches may have little to no effect on students' empathy scores (SMD -0.13, 95% CI -0.68 to 0.43; 3 studies, 421 participants; I² = 82%; low-quality evidence) or on rapport (SMD 0.02, 95% CI -0.33 to 0.38; 3 studies, 176 participants; I² = 19%; moderate-quality evidence) compared to face-to-face approaches. There may be small negative effects of electronic interventions on information giving skills (low-quality evidence), and effects on information gathering skills are uncertain (very low-quality evidence).  Personalised/specific feedback probably improves overall communication skills to a small degree in comparison to generic or no feedback (SMD 0.58, 95% CI 0.29 to 0.87; 6 studies, 502 participants; I² = 56%; moderate-quality evidence). There may be small positive effects of personalised feedback on empathy and information gathering skills (low quality), but effects on rapport are uncertain (very low quality), and we found no evidence on information giving skills. We are uncertain whether role-play with simulated patients outperforms peer role-play in improving students' overall communication skills (SMD 0.17, 95% CI -0.33 to 0.67; 4 studies, 637 participants; I² = 87%; very low-quality evidence). There may be little to no difference between effects of simulated patient and peer role-play on students' empathy (low-quality evidence) with no evidence on other outcomes for this comparison. Descriptive syntheses of results that could not be included in meta-analyses across outcomes and comparisons were mixed, as were effects of different interventions and comparisons on specific communication skills assessed by the included trials. Quality of evidence was downgraded due to methodological limitations across several risk of bias domains, high unexplained heterogeneity, and imprecision of results. In general, results remain consistent in sensitivity analysis based on risk of bias and adjustment for clustering. No adverse effects were reported.  AUTHORS' CONCLUSIONS: This review represents a substantial body of evidence from which to draw, but further research is needed to strengthen the quality of the evidence base, to consider the long-term effects of interventions on students' behaviour as they progress through training and into practice, and to assess effects of interventions on patient outcomes. Efforts to standardise assessment and evaluation of interpersonal skills will strengthen future research efforts.

Doctor, Will You Pray for Me? Responding to Patients' Religious and Spiritual Concerns.

Religion and spirituality in the United States have been shifting, and physicians are treating patients with increasingly diverse beliefs. Physicians' unfamiliarity with these beliefs poses critical challenges for medical education and practice. Despite efforts to improve medical education in religion/spirituality, most doctors feel their training in these areas is inadequate. This article draws on the author's conversations with providers and patients over several years in various clinical and research contexts in which religious/spiritual issues have arisen. These conversations provided insights into how patients and their families commonly, and often unexpectedly, make religious/spiritual comments to their providers or question their providers about these topics, directly or indirectly. Comments are of at least 9 types that fall within 4 broad domains: (1) perceiving God's role in disease and treatment (in causing disease, affecting treatment outcomes, and knowing disease outcomes), (2) making medical decisions (seeking God's help in making these decisions and determining types/extents of treatment), (3) interacting with providers (ascertaining providers' beliefs, having preferences regarding providers, and requesting prayer with or by providers), and (4) pondering an afterlife. Because of their beliefs or lack of knowledge, doctors face challenges in responding and often do so in 1 of 4 broad ways: (1) not commenting, (2) asking strictly medical questions, (3) referring the patient to a chaplain, or (4) commenting on the patient's remark. Medical education should thus encourage providers to recognize the potential significance of patients' remarks regarding these topics and to be prepared to respond, even if briefly, by developing appropriate responses to each statement type. Becoming aware of potential differences between key aspects of non-Western faiths (e.g., through case vignettes) could be helpful. Further research should examine in greater depth how patients broach these realms, how physicians respond, and how often medical school curricula mention non-Western traditions.

The physician healer track: educating the hearts and the minds of future physicians.

Calls to reform medical education recommend explicit training in professional identity formation to promote the development of humanistic, compassionate physicians. The authors report their experience offering The Physician Healer Track, a 500-contact-hour curricula integrated over 4 years, focusing on self-awareness, reflection, being-with-suffering, communication and professional identity development. The voluntary scholarly-concentration program comprises 4 years of monthly dinner meetings with faculty mentors, a two-month preceptorship in the first year, a one-month immersion course in MS4 and one elective. Training in mindfulness, cognitive behavioral therapy, nonviolent communication, motivational interviewing, spirituality in healthcare, wellness, equanimity, and 'being with suffering' is reinforced across all 4 years. Community building and reflection are integral to the training both in the monthly sessions and the immersion courses. Enrollment has grown from 26 students in the first year (11% of class) to a total of 258 students across our first 6 years (average of 20-26% of each class). Graduates in our first two cohorts of PHT have exceeded the numbers in the eight other scholarly concentrations offered at UTMB. Among students participating in the summer preceptorship, there has been less than 1% attrition. In serial assessments, students report continued growth in personal development, professional development, and the ability to empathize. Offering PHT has resulted in the growth of training for our medical residents, faculty, physical therapy students and the creation of a student healer association. Despite the demands on student's time, they are voluntarily participating in a challenging program of integrated training with the intention of keeping them connected to their humanity during the rigors of medical school training.

Mindfulness in healthcare professionals and medical education.

Healthcare professionals are exposed not only to the ubiquitous stress, but also to the culture of perfectionism. Therefore, they need tools to achieve a balance between work and rest in order to effectively help their patients. The study objective is a review of the literature on the implementation of mindfulness in healthcare professionals and medical students. The authors searched the literature in PubMed and Google Scholar databases for publications about "mindfulness" in "healthcare professionals" and "medical students." The search included manuscripts published to July 31, 2019. Mindfulness is a process of intentional paying attention to experiencing the present moment with curiosity, openness and acceptance of each experience without judgment. Mindfulness training leads to a better mood perception, lower stress perception, and responding to stimuli more effectively. All these features can have a potentially positive effect on healthcare service. The paper describes methods of intervention as well as their effects, which may be useful both in maintaining the well-being of healthcare professionals and in patient care. Mindfulness meditation has a beneficial effect on stress, depression, burnout, well-being and empathy among doctors, nurses and other healthcare workers. However, the method has a number of limitations, including a small number of participants, a high dropout rate in the intervention group and, above all, ceasing to practice mindfulness in the longer term after the course termination. Mindfulness can be widely implemented by healthcare professionals, thus improving their well-being and the quality of care they provide. Further standard scientific research is needed to confirm this impact. Int J Occup Med Environ Health. 2021;34(1):1-14.

Desenvolvimento de um programa de mentoria por pares estudantis: um relato de experiência / Development of a mentoring program by student peers: an experience report

Resumo: Introdução: A transição do colégio para a universidade configura-se como um período de profundas mudanças, seja no âmbito acadêmico, social, pessoal ou familiar. Nesse processo, responsabilidades são adquiridas, fazendo com que essa transição possa ser marcada por inúmeras incertezas. Nesse sentido, o projeto "Mentorias: conectando estudantes", elaborado pela IFMSA Brazil FMT na Universidade de Taubaté, objetiva fornecer aos calouros o suporte necessário para tornar essa experiência mais gratificante. Relato de experiência: A primeira edição do projeto foi desenvolvida ao longo de cinco meses durante o ano de 2020, organizada em quatro fases: 1. construção do material teórico para os mentores; 2. pesquisa e seleção de calouros e veteranos interessados em participar do projeto; 3. gravação das capacitações on-line para os mentores; 4. determinação da dupla mentor-pupilo e desenvolvimento da mentoria com posterior coleta e análise de feedback. Dessa forma, contemplou estudantes de Medicina, a partir do terceiro período, que atuaram como mentores, abordando, em reuniões remotas semanais, durante dois meses, os quatro pilares do projeto: acadêmico, pesquisa, desenvolvimento pessoal e extensão, com os seus respectivos pupilos (acadêmicos do primeiro e segundo períodos). Discussão: O sistema de mentoria vertical por pares estudantis tem se mostrado uma estratégia promissora no preparo e na recepção dos alunos para a vida acadêmica e profissional, uma vez observado que o vínculo gerado entre calouro e veterano favorece o engajamento dos alunos recém-ingressantes com as atividades e oportunidades dentro da IES. Conclusão: O objetivo deste relato é demonstrar, da perspectiva da equipe idealizadora, a experiência de realização do projeto, ao longo da sua primeira edição e incentivar a criação de programas e projetos em outras IES voltados para o acolhimento do calouro por "veteranos" de uma forma mais holística. Os resultados obtidos foram benéficos, tanto para mentores quanto para pupilos, para o fortalecimento do vínculo criado e do engajamento em atividades acadêmicas.

Abstract: Introduction: The transition from high school to the university constitutes a period of profound changes, whether in the academic, social, personal or family spheres. In this process, responsibilities are acquired, and it can be marked by countless uncertainties. In this sense, the project: "Mentorias - conectando estudantes", developed by IFMSA Brazil FMT, at the University of Taubaté, aims to provide first-year students with the necessary support to make this experience more gratifying. Experience report: The first edition of the project was developed over five months and organized in four phases: (1) construction of theoretical material for the mentors; (2) research and selection of interested first-year and senior students in the project; (3) recording of online training for mentors; (4) pairing of the Mentor-Mentee, development of the mentoring program with subsequent collection and analysis of feedback. To this end, medical students from the third semester onwards acted as mentors, conducting weekly remote meetings for two months, addressing the four pillars of the project: Academic, Research, Personal Development and Extension, with their respective first-year student mentee. Discussion: The vertical mentoring system by student peers has proven to be a promising strategy in preparing and receiving students for academic and professional life, as the bond formed between the first-year student and senior helps engage the former in activities and opportunities within the Higher Education Institution (HEI). Conclusion: The objective of the report is to demonstrate, from the perspective of the organizing team, the experience of conducting the first edition of the project in order to encourage the creation of programs and projects in other HEIs aimed at new students being welcomed by seniors, in a more holistic fashion. The results achieved were beneficial, both for mentors and mentees, in strengthening the relationship created and the engagement in academic activities.

O ensino da saúde do idoso no curso médico: os desafios na formação para o cuidado / La enseñanza de la salud del anciano en el curso médico: los desafíos en la formación para el cuidado / Teaching health of the elderly in a medical course: challenges in the education for care

A educação médica tem sido tensionada por diferentes modelos, que podem mobilizar conhecimentos essencialmente biomédicos ou também de ordem psicossocial. O presente artigo busca abordar como tais conhecimentos se relacionam com o ensino da saúde do idoso na disciplina Cuidado Integral à Saúde do Idoso, do curso médico de uma universidade pública do interior de Minas Gerais. Trata-se de uma pesquisa de campo, de abordagem qualitativa, na qual foram feitas observações de aulas teóricas e práticas, entrevistas e análise documental. Os resultados indicaram que as aulas teóricas não se orientam por meio dos cenários de práticas, e esses, por sua vez, demonstram potencial em apresentar aos estudantes a complexidade do processo saúde-doença. Por fim, as relações teoria-prática, escola-serviço e seus modelos de atenção são desafios na formação médica para o cuidado integral com o idoso. (AU)

La educación médica ha sufrido tensión por diferentes modelos que pueden movilizar conocimientos esencialmente biomédicos o también de orden psicosocial. El presente artículo busca abordar cómo tales conocimientos se relacionan con la enseñanza de la salud del anciano en la asignatura Cuidado Integral de la Salud del Anciano, del curso médico de una universidad pública del interior del Estado de Minas Gerais. Se trata de una investigación de campo, de abordaje cualitativo, en la cual se realizaron observaciones de clases teóricas y prácticas, entrevistas y análisis documental. Los resultados mostraron que las clases teóricas no se orientan a partir de los escenarios de prácticas y estos, a su vez, demuestran potencial para presentar a los estudiantes la complejidad del proceso salud-enfermedad. Por fin, las relaciones teoría-práctica, escuela-servicio y sus modelos de atención son desafíos en la formación médica para el cuidado integral del anciano. (AU)

Medical education has been stressed by different models, which can motivate essentially biomedical and psychosocial knowledge. This article looks at how this knowledge relates to the teaching of health of the elderly, in the Comprehensive Care for the Health of the Elderly discipline, from the medical course of a public university in the interior of Minas Gerais. For data collection a qualitative approach was utilized, in which observations of theoretical and practical classes as well as interviews and documentary analysis was made. The results indicated that the theoretical classes have no planned relationship to the practice scenarios. The latter, on the other hand, demonstrate the potential to introduce students to the complexity of the health-disease process. In conclusion, the theory-practice, school-service relationships and their care models present challenges in medical training for integral health care of the elderly. (AU)

Matriz de competências para o ensino da homeopatia na graduação médica / Competency matrix for undergraduate medical education in homeopathy

Resumo: Introdução: Currículos médicos de graduação são extremamente carregados em seu conteúdo, tornando-se primordial a necessidade de otimizar competências essenciais. As Diretrizes Curriculares Nacionais (DCN) do Curso de Graduação em Medicina preconizam uma valorização do tratamento do doente que possui muitas interfaces com a homeopatia. Apesar de ser uma especialidade médica no Brasil reconhecida desde 1980, a homeopatia ainda é pouco presente na graduação médica. Objetivo: Este estudo teve como objetivo desenvolver uma matriz de competências essenciais composta de conhecimentos e habilidades desejáveis para o ensino da homeopatia na graduação médica. Métodos: Trata-se de um estudo quanti-qualitativo realizado por meio da técnica Delphi normativa, em duas rodadas, com os docentes especialistas em homeopatia do país. Na primeira rodada, aplicou-se um questionário anônimo on-line para identificar as competências (conhecimentos e habilidades) necessárias em homeopatia para os discentes de graduação em Medicina. Após a análise de conteúdo, os temas foram agrupados nessas duas categorias que retornaram para apuração na segunda rodada, em que os especialistas assinalaram o grau de concordância (escala de Likert de quatro pontos: de não relevante a muito relevante). Para a definição de consenso, adotaram-se dois critérios: índice de De Loe e uma nota de relevância adotada pelos autores com vistas a discriminar mais os graus de consenso. Resultados: Dos 14 temas/subtemas relacionados como competências/conhecimentos, consideraram-se 11 como de alto consenso, dos quais cinco foram avaliados como primordiais, pois obtiveram nota de relevância acima de 9,0 (três relacionados ao grande tema clínica homeopática; um, à teoria e técnica homeopáticas; e outro, à pesquisa homeopática). Em relação às competências/habilidades, oito das 11 foram consideradas de alto consenso, e somente duas alcançaram nota acima de 9,0, ambas relacionadas à clínica homeopática. Conclusão: O ensino da homeopatia pode contribuir para a mudança paradigmática da medicina no sentido de valorizar o doente e promover a saúde, permitindo uma atuação médica mais humanizada e centrada no doente, o que justificaria a adoção de seu ensino, inclusive obrigatório, nas faculdades de Medicina. A elaboração de uma matriz de competências do que deve ser ensinado de homeopatia aos discentes da graduação médica vem ao encontro das DCN e instrumentaliza a reflexão na elaboração de uma futura ementa.

Abstract: Introduction: Undergraduate medical curricula are overloaded with content, making the need to optimize essential skills and knowledge paramount. The National Curricular Guidelines for the medical course (DCNs) put focus on patient treatment, which involves several interfaces with homeopathy. However, despite it being recognized as a medical specialty in Brazil since 1980, homeopathy is rarely present in undergraduate medical education. Objective: To develop a collection of essential skills and knowledge for teaching homeopathy as part of the undergraduate medical curriculum. Methods: Quanti-qualitative study performed using the standard Delphi technique in two rounds with specialized homeopathy teachers from Brazil. An anonymous online questionnaire was conducted to identify the learning competences needed in homeopathy for undergraduate medical students. Following content analysis, the themes and sub-themes were grouped into the two main categories of knowledge and skills, which were returned to the specialists who rated their importance for each item using the "Four-Point Likert Scale" from not at all important to very important. For the purpose of generating a general consensus, two criteria were adopted: the "De Loe index" and a importance score. Results: There was a high degree of consensus regarding eleven of the fourteen themes/sub-themes, five of which were considered essential, with an importance score above 9.0 (three related to the general theme, Homeopathic Clinic, one to Homeopathic Theory and Method and another to Homeopathic Research). There was also a high level of consensus regarding eight of the eleven skills, but only two gained a score of above 9.0, both related to Homeopathic Clinic. Conclusion: The teaching of Homeopathy can contribute to a paradigmatic change in medicine, particularly in the sense of prioritizing the patient and promoting health, as well as allowing for a more humanized and patient-centered medical engagement. These factors would justify the adoption of its teaching, so much so it could be made mandatory across all medical study. The establishment of a "competency matrix" for homeopathy study, which ought to be taught to students of the medical field, meets the DCNs and would be instrumental in future syllabuses.

Semiology and radiology integration: a new trend in the teaching-learning process / Integração semiologia e radiologia: nova tendência no processo de ensino e aprendizagem

Abstract: Introduction: The development of clinical reasoning to diagnose diseases and order ancillary tests, such as radiology imaging, is based on history-taking and physical examination skills, which are developed during the semiology course. Objective: We aimed to evaluate the results of the innovative integration of two courses in the medical curriculum at our institution: Medical Semiology and Clinical Radiology. Methods: The sample consisted of 184 fifth-semester medical students attending the two courses simultaneously. Extra-class semiology-radiology sessions based on theoretical and practical topics integrating radiological images and semiological signs were conducted, and the results were assessed by applying a semi-structured questionnaire to the participants, in which all 18 items were rated on a scale from 0 (worst) to 10 (best). The normality hypothesis in score distribution was verified by the Kolmogorov-Smirnov test and the Shapiro-Wilk test. The distribution of the 18 scores were summarized by descriptive statistics and compared by Friedman's test, with post-hoc test in pairwise comparisons adjusted by Bonferroni test. Correlations between the scores were determined by Spearman's Rank Correlation Coefficients. Results: The overall mean score for the semiology-radiology sessions was high (8.55). Students were satisfied with the selection of clinical cases (8.46) and found that the semiology-radiology sessions contributed to the development of their clinical reasoning (8.58). Conclusion: Medical schools are facing new challenges in medical education. The innovative concept of Radiology-Semiology integrated teaching modality affects the students' self-perception ability to interpret radiological images and might be an educational strategy trend.

Resumo: Introdução: O desenvolvimento do raciocínio clínico para diagnosticar doenças e solicitar exames complementares, como os radiológicos, baseia-se na história e no exame físico, desenvolvidos durante o curso de Semiologia. Objetivo: Nosso objetivo foi avaliar os resultados da integração inovadora de duas disciplinas no currículo médico em nossa instituição: Semiologia Médica e Radiologia Clínica. Métodos: A amostra foi composta por 184 estudantes de Medicina do quinto semestre que participaram das duas disciplinas simultaneamente. Realizaram-se sessões extraclasse de semiologia e radiologia, baseadas em tópicos teóricos e práticos, integrando imagens radiológicas com sinais semiológicos. Avaliaram-se os resultados por meio da aplicação de um questionário semiestruturado aos participantes, no qual todos os 18 itens foram classificados em uma escala de 0 (pior) a 10 (melhor). A hipótese de normalidade na distribuição dos escores foi verificada pelos testes de Kolmorov-Smirnov e Shapiro-Wilk. As 18 distribuições de pontuação foram resumidas por estatística descritiva e comparadas pelo teste de Friedman, com teste post hoc em comparações pareadas ajustadas por Bonferroni. As correlações entre as pontuações foram determinadas pelos coeficientes de correlação de classificação de Spearman. Resultados: O escore médio geral para as sessões de semiologia e radiologia foi alto (8,55). Os estudantes ficaram satisfeitos com a seleção de casos clínicos (8,46) e descobriram que as sessões de semiologia-radiologia contribuíram para o desenvolvimento de seu raciocínio clínico (8,58). Conclusão: As escolas médicas enfrentam novos desafios na educação médica. O conceito inovador da modalidade de ensino integrado de radiologia-semiologia afeta a capacidade de autopercepção dos alunos para interpretar imagens radiológicas e pode ser uma tendência de estratégia educacional.

Interprofessional versus uniprofessional dyad learning for medical students in a clinical setting.

OBJECTIVES: The aim of the present study was to explore and compare medical students' perceived learning outcomes when treating patients under supervision in two different learning settings: a uniprofessional or an interprofessional dyad. METHODS: The design of the study is a qualitative interview study. Data were collected from October 2016 to June 2017 via semi-structured group interviews performed at the end of the clinical placement in an orthopaedic outpatient clinic for medical students in the last semester of the curriculum. In the placement, the students worked by turns in either a uniprofessional dyad with two medical students or an interprofessional dyad with a nursing student. The data from the interviews were analysed using Systematic Text Analysis. RESULTS: Overall, 21 students were interviewed. The students appreciated the authenticity of dealing with real patient problems. Both dyads provided the possibility of working as a professional, but the interprofessional dyad had a more authentic setting. In both dyads, the students' interdependence and mutual support promoted the acquisition of knowledge and skills. Working in the interprofessional dyad facilitated relationships between the professions, and the medical students became aware of some of their own profession's strengths and weaknesses. The interprofessional collaboration contributed to different perspectives on the patients' course of treatment and led to a more holistic understanding of the treatment. CONCLUSIONS: Interprofessional dyads have the potential to improve learning outcomes in the clinical training of medical students. Further studies are needed to explore the benefits across medical specialities and settings.

Medical Education's Wicked Problem: Achieving Equity in Assessment for Medical Learners.

Despite a lack of intent to discriminate, physicians educated in U.S. medical schools and residency programs often take actions that systematically disadvantage minority patients. The approach to assessment of learner performance in medical education can similarly disadvantage minority learners. The adoption of holistic admissions strategies to increase the diversity of medical training programs has not been accompanied by increases in diversity in honor societies, selective residency programs, medical specialties, and medical school faculty. These observations prompt justified concerns about structural and interpersonal bias in assessment. This manuscript characterizes equity in assessment as a "wicked problem" with inherent conflicts, uncertainty, dynamic tensions, and susceptibility to contextual influences. The authors review the underlying individual and structural causes of inequity in assessment. Using an organizational model, they propose strategies to achieve equity in assessment and drive institutional and systemic improvement based on clearly articulated principles. This model addresses the culture, systems, and assessment tools necessary to achieve equitable results that reflect stated principles. Three components of equity in assessment that can be measured and evaluated to confirm success include intrinsic equity (selection and design of assessment tools), contextual equity (the learning environment in which assessment occurs), and instrumental equity (uses of assessment data for learner advancement and selection and program evaluation). A research agenda to address these challenges and controversies and demonstrate reduction in bias and discrimination in medical education is presented.

"Kampo-sommelier Practice": A Trial for an Active Learning Program in Kampo (Japanese Traditional) Medicine.

OBJECTIVE: This study aimed to assess the effectiveness of Kampo-sommelier practice, an active learning program on crude drugs used in Kampo formulations. METHODS: The participants were fourth-year Tokai University School of Medicine students as of 2017. Eighteen small teams attended a 20-minute Kampo-sommelier practice session and were provided 10 kinds of crude drugs (Licorice, Cinnamon, Ginger, etc.) in three forms, original, cut, and powdered, while blinded to the drugs. Each team was asked to distinguish each drug in terms of form, scent, flavor, and color with reference to described characteristics. The ability to match the names of the drugs with their descriptions was assessed in the participants one month later, and also in human science "A" and medicine "B" students, without prior education, and pharmacy "C" students, with professional education. RESULTS: The 117 participants received an average score of 6.2 ± 2.4 (mean ± S.D.) out of 10, which was significantly higher than 3.4 ± 1.8 in 97 "A" students and 3.1 ± 2.4 in 85 "B" students and lower than 8.4 ± 2.1 in 135 "C" students (p < 0.05 for all). CONCLUSIONS: The effectiveness of this team-based learning approach is suggested by the significantly higher scores of the participants.

Does Empathy Decline in the Clinical Phase of Medical Education? A Nationwide, Multi-Institutional, Cross-Sectional Study of Students at DO-Granting Medical Schools.

PURPOSE: To examine differences in students' empathy in different years of medical school in a nationwide study of students of U.S. DO-granting medical schools. METHOD: Participants in this cross-sectional study included 10,751 students enrolled in 41 of 48 campuses of DO-granting medical schools in the United States (3,616 first-year, 2,764 second-year, 2,413 third-year, and 1,958 fourth-year students). They completed a web-based survey at the end of the 2017-2018 academic year that included the Jefferson Scale of Empathy and the Infrequency Scale of the Zuckerman-Kuhlman Personality Questionnaire for measuring "good impression" response bias. Comparisons were made on empathy scores among students in different years of medical school using analysis of covariance, controlling for the effect of "good impression" response bias. Also, comparisons were made with preexisting data from students of U.S. MD-granting medical schools. RESULTS: A statistically significant decline in empathy scores was observed when comparing students in the preclinical (years 1 and 2) and the clinical (years 3 and 4) phases of medical school (P < .001); however, the magnitude of the decline was negligible (effect size =0.13). Comparison of findings with MD students showed that while the pattern of empathy decline was similar, the magnitude of the decline was less pronounced in DO students. CONCLUSIONS: Differences in DO-granting and MD-granting medical education systems, such as emphasis on provision of holistic care, hands-on approaches to diagnosis and treatment, and patient-centered care, provide plausible explanations for disparity in the magnitude of empathy decline in DO compared with MD students. More research is needed to examine changes in empathy in longitudinal study and explore reasons for changes to avert erosion of empathy in medical school.

Patient/service user involvement in medical education: A best evidence medical education (BEME) systematic review: BEME Guide No. 58.

Background: The extent to which patients and service users are involved in medical education varies widely. There is a need for an up to date systematic review of the literature that examines what involvement (description), the potential outcome of such involvement (justification) and 'why' such involvement impacts students (clarification).Methods: Systematic searches of four databases were undertaken. Citations were screened and consensus reached for inclusion/exclusion of studies. Quality of study design and interventional presentation were assessed.Results: Of the 39 studies included in the review, 4 studies were encounter based, 17 sharing experiences, 16 with patients involved in teaching, 2 studies describing consumers as tutors, and none with involvement at the institutional level. Outcomes in terms of benefits to learners included increased empathy and understanding of illness as experienced by patients, improved communication with patients and a greater understanding of patient-center care. Educational quality assessment showed specific weaknesses in theoretical underpinning, curriculum outcomes, content or pedagogy.Conclusions: Patients can enrich medical education by allowing learners to explore patient-centered perspectives in holistic care. For educators this review highlights the lack of an underpinning conceptual basis for which to translate theory into practice.

Clinical Impact of the Introduction of Pediatric Intussusception Air Enema Reduction Technology in a Low- to Middle-Income Country Using Low-Cost Simulation-Based Medical Education.

INTRODUCTION: Pediatric intussusception is a common cause of bowel obstruction in infants. Air enema (AE) reduction is routine first-line management in many countries; however, there is a high rate of operative intervention in low- and middle-income countries. The aims of the study were to use simulation-based medical education with an intussusception simulator to introduce AE reduction to Myanmar and to assess its effect on provider behaviors and the resulting clinical care. METHODS: Clinical evaluation was conducted by comparing clinical outcomes data for children with intussusception 12 months before implementation with that from 12 months subsequent to implementation. These included the following: AE success rates, recurrence rates, length of stay, intestinal resection, and operative intervention rates. An educational workshop was developed that used a low-cost mannequin to facilitate practice at the reduction of intussusception using AE. Curriculum evaluation was performed through 5-point rating scale self-assessment in several domains. Data analysis was performed with Mann-Whitney U test, Student t test, or Wilcoxon signed-ranks test as appropriate; a P value of less than 0.05 was considered to be significant. RESULTS: After implementation, there was a significant reduction in the overall operative intervention rates [82.5% (85/103) vs. 58.7% (44/75), P = 0.006]. Intestinal resection rates increased [15.3% (13/85) vs. 35.9% (14/39), P = 0.02]. The success rate with attempted AE reduction was 94.4% (34/36), with a recurrence rate of 5.6% (2/36). The simulation-based medical education workshop was completed by 25 local participants. There was a significant difference in the confidence of performing (1.9 vs. 3.6, P ≤ 0.0001) or assisting (2.8 vs. 3.7, P = 0.018) an AE reduction before and after the workshop. CONCLUSIONS: Simulation-based educational techniques can be successfully applied in a low- and middle-income country to facilitate the safe introduction of new equipment and techniques with significant beneficial impact on provider behaviors and the resulting clinical care.

Interprofessional nutrition management - implementation and evaluation of a course for medical and nursing students using research-based learning method.

Objective: The aim of the teaching project "Interprofessional Nutrition Management in Inpatient and Home Care" of the Medical Faculty of the Heinrich Heine University (HHU) and the Fliedner University of Applied Sciences Düsseldorf (FFH) was to test an interprofessional training session on the topic of malnutrition using the method of research-based learning to evaluate feasibility. Method: In the teaching project for medical and nursing students, research-based learning was applied in a case-based cross-sector setting. The teaching project was assessed quantitatively by the participating students through questionnaires and four newly-developed scales. The modeling and reliability of the scales (from 1 to 5) was confirmed by an exploratory factor analysis and Cronbach's alpha. The scales were evaluated descriptively and through inferential statistics. Results: The medical (n=21) and nursing students (n=25) rated the teaching project positively. Across all professional groups, the social context between the students (M=4.6) and the relevance of the topic (M=4.47) were rated very highly. The use of research-based learning (M=3.9) and the final assessment of the training session (M=3.9) were rated as satisfactory. Conclusions: The method of research-based learning proved to be very suitable for interprofessional education, as it enabled situations which encouraged the health professionals to learn from one another, about one another and with one another. Through the interdisciplinary discussion of malnutrition, cooperation skills and initial competences in nutritional management can be cultivated in future doctors and nursing staff even during training.

Training the next generation of Africa's doctors: why medical schools should embrace the team-based learning pedagogy.

BACKGROUND: As far back as 1995, the Cape Town Declaration on training Africa's future doctor recognized the need for medical schools to adopt active-learning strategies in order to nurture holistic development of the doctor. However, medical education in Africa remains largely stuck with traditional pedagogies that emphasize the 'hard skills' such as knowledge and clinical acumen while doing little to develop 'soft skills' such as effective communication, teamwork, critical thinking or life-long learning skills. By reviewing literature on Africa's epidemiologic and demographic transitions, we establish the need for increasing the output of well-trained doctors in order to match the continent's complex current and future healthcare needs. Challenges that bedevil African medical education such as outdated curricula, limited educational infrastructure and chronic resource constraints are presented and discussed. Furthermore, increased student enrollments, a trend observed at many schools, coupled with chronic faculty shortages have inadvertently presented specific barriers against the success of small-group active-learning strategies such as Problem-Based and Case-Based Learning. We argue that Team-Based Learning (TBL) offers a robust alternative for delivering holistic medical education in the current setting. TBL is instructor-driven and embodies key attributes that foster development of both 'hard' and 'soft' skills. We elaborate on advantages that TBL is likely to bring to the African medical education landscape, including increased learner enthusiasm and creativity, accountability, peer mentorship, deep learning and better knowledge retention. As with all new pedagogical methods, challenges anticipated during initial implementation of TBL are discussed followed by the limited pilot experiences with TBL in Africa. CONCLUSION: For its ability to enable a student-centered, active learning experience delivered at minimum cost, we encourage individual instructors and African medical schools at large, to adopt TBL as a complementary strategy towards realizing the goal of training Africa's fit-for-purpose doctor.